Not all orthodontic cases can be treated with aligners or braces alone. Some patients present with skeletal discrepancies, severe crowding, or bite misalignment that require a more advanced, multi-phase approach.
In these situations, orthodontists may combine several treatments to achieve optimal results, including:
Watch this real case discussion from Dr. Shapiro here:
A maxillary skeletal expander (MSE) is used to widen the upper jaw when it is too narrow.
This approach:
Unlike traditional expanders, skeletal expanders anchor directly to bone, making them more effective in adults where jaw growth has already stopped.
In complex cases, tooth extractions—often premolars—may be necessary to:
In this case, lower premolar extractions would help upright the lower incisors, improving both function and aesthetics.
However, treatment plans are not always fixed. If teeth have significant decay or damage, extraction decisions may change.
An important detail highlighted in this case is the presence of large cavities in the lower posterior teeth.
This can significantly alter the treatment plan:
This is why a comprehensive evaluation is critical before starting orthodontic care. Learn more about diagnostic technology on the 3D CT Scanning page.
For severe skeletal imbalances, double jaw surgery is often the most effective solution.
This procedure:
Cases like this one are typically managed through surgical orthodontics, where orthodontists and oral surgeons work together to achieve the best outcome.
In complex cases, orthodontists must also evaluate for underlying conditions like condylar resorption.
This condition involves:
Identifying these signs early helps prevent complications and ensures a more stable result. You can learn more about jaw-related conditions on the TMJ Therapy page.
One of the most important takeaways from this case is that orthodontic treatment is not one-size-fits-all.
Plans may evolve based on:
At Wall Street Orthodontics, every treatment plan is customized using advanced diagnostics and a comprehensive understanding of facial structure and function.
Before beginning treatment, a full evaluation may include:
Tools like Digital Impressions (iTero) help create precise, personalized treatment plans from the start.
Working with an experienced orthodontist like Dr. Lucas W. Shapiro, DDS ensures that even the most complex cases are handled with expertise and attention to detail.
A maxillary skeletal expander is a device used to widen the upper jaw, especially in adults where traditional expansion is less effective.
No. Extractions are only recommended when necessary to achieve proper alignment and long-term stability.
Yes. Severely decayed teeth may need to be extracted, which can change the overall treatment plan.
Double jaw surgery repositions both the upper and lower jaws to correct severe bite and alignment issues.
It is a condition involving deterioration of the jaw joint, which can affect treatment outcomes if not properly managed.
If you’ve been told your case is too complicated—or you want a second opinion—Wall Street Orthodontics offers advanced solutions tailored to your unique needs.
Schedule your consultation today:
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Saturday: 8:30 AM - 1:30 PM
Sunday: Closed
